exchange transfusion

1. NEONATAL JAUNDICE
DR FARAH HASSAN
HOUSE OFFICER PEADIATRICS

2. NEONATAL JAUNDICE
 Yellowish discolouration of skin, sclera and
mucosa.
 Increase concentration of bilirubin in the
blood.

3. INCIDENCE
 60% of term infants
 80% of preterm infants

4. PHOTOTHERAPY
 PRINICIPLE
. Bilirubin absorb visible light in the blue
region(420- 490nm)and convert fat soluble
unconjugated bilirubin into non-toxic ,water-soluble
form by photo-isomerization and photo-oxidation and
excreted in bile and urine.

7. SIDE EFFECT
 Loose stools
 Hypothermia or hyperthermia
 Rashes
 Dehydration
 Damage to exposed eyes and genitelia
 Bronze baby syndrome with conjugated
hyperbilirubinemia phototherapy causes photo
destruction of copper porphyries cause urine and skin to
become bronze in colour.

8. Phototherapy Rash

9. EXCHANGE TRANSFUSION
 It is a procedure in which the patient’s blood is
exchanged with a donor blood, blood components and
fluids in order to remove abnormal blood or toxins
• TYPES:
Partial ET
Single volume ET
Double volume ET

10. INDICATIONS
 • HYPERBILIRUBINEMIA

 • SEPSIS

 • SEVERE ANEMIA

 • POLYCYTHEMIA

 • SICKLE CELL ANEMIA

 • DIC

 • HYDROPS FETALIS

 • POISINING

11. ACCESS
 CENTRAL VIA THE UMBLICAL VEIN

 • PERIPHERAL VIA PERIPHERAL VEIN

12. BLOOD TEST PRIOR TO
EXCHANGE
 BIOCHEMISTRY
 FULL SEPTIC WORKUP
 ON CORD BLOOD:
 DIRECT COOMBS TEST
 HB
 SERUM BILIRUBIN
 ON BABYS BLOOD.
 ABO, RH FACTOR, DIRECT COOMBS TEST

13. TYPES OF BLOOD NEEDED
 • O Rh –ive blood is used

 • If available before delivery, cross match against mothers blood

 • If obtained after delivery ,cross match with infants blood

14. AMOUNT OF BLOOD FOR
DOUBLE EXCHANGE
 85* wt *2

 This removes 85% of infants rbcs

 At end of exchange bilirubin should be about 50% of pre

 exchange level

15. BASELINE OBSERVATION
 • Vital signs

 • Blood sugar level

 • Abdominal girth measurement to evaluate haemorrhage

 • Urine analysis

 • Infants color tone activity

16. PRINCIPLES
 Carried through a catheter using a three way cannula
 Blood is drawn out of baby 5-20ml and discarded
down outflow line
 Aliquots 5ml for 1kg, 10ml for 2kg,, 15ml for 3kg,
>3kg 20ml cycles
 Donor blood is warmed drawn into a syringe and
injection slowly.

17. PRINCIPAL
 App 100ml/ 15min should be exchanged
 Record exact amount of blood exchanged
 Equal volumes exchanged in and out
 Vital signs recorded every 15 mins

18. RISK DURING EXCHANGE
 Blood overload congestive heart failure
 Insufficient blood anaemia
 Perforation with catheter
 Air or blood embolism

19. COMPLICATION
 Infection
 Haemorrhage
 Anaemia
 Trauma to vessels
 Arrhythmia and cardiac failure
 Hypotension and shock
 Electrolyte imbalance
 Graft vs host disease

20. VIDEO

21. PHARMACOLOGICAL THERAPY
 Phenobarbital
 Action:
Induce production of glucoronyltransferase and
Increase bilirubin excretion
 Indication:
CNJ II syndrome and Gilbert syndrome
 Dose:
2.5 mg/kg/day
 Metalloporphyrins
Synthetic heme ,inhibit heme oxygenase thus decrease
the production of bilirubin

22. PHARMACOLOGICAL THERAPY
 Intravenous Albumin
Given 1g/kg over 2 hours can provide more
binding sites for free bilirubin
 Iv immunoglobulin
Block fc receptors in neonatal reticuloendothelial system
and prevent further haemolysis is recommended if TSB
is rising despite intensive phototherapy
 Dose:500mg -1g/kg over 2hours
 Repeated after 12 hours

23. MANAGEMENT OF CONJUGATED
BILIRUBIN
 MEDICAL MANAGEMENT
 Antibiotics (sepsis, UTI)
 L-thyroxin (hypothyroidism)
 Hormone replacement therapy
 Vitamins
 Dietary restriction

24. PHARMACOLOGICAL THERAPY
 Ursodiol
 20 mg /kg /day in 2 divided doses
 Phenobarbital
 3-5mg/kg /day
 Cholestyramin
 Surgical management